2017 HSC Section 2 - Practice Management

January Y March & 2016

Health Care Management Review

Practice Implications Poor patient handoffs result in adverse medical and finan- cial consequences but can be improved through targeted efforts to improve patient safety. We found that perceptions of successful patient handoffs can be influenced by percep- tions of organizational factors such as teamwork, having hospital leadership demonstrate that safety is a priority, and sufficient staffing. Hospitals concerned about patient hand- offs should rank improvements in teamwork across units as a top priority and consider initiatives that foster open com- munications, such as teamwork training. Sufficient staffing should also be provided, recognizing that resource con- straints may limit some organizations’ abilities to add staff. Finally, leadership should demonstrate support for safety. Methods to demonstrate support include the formation of a safety committee and an evaluation of safety performance as part of a manager’s annual performance appraisal.

Limitations and Suggestions for Future Research

Common method bias, the degree to which correlations are altered because of a methods effect, is a potential problem in survey research and may appear when there is simultaneous measurement of predictor and outcome variables. We as- sessed common method bias with Harman’s single factor test and a confirmatory factor analysis, consistent with ap- proaches used by other studies in the literature (Schoenherr & Swink, 2012). These assessments indicated that common method bias was not a significant threat to the validity of our findings; specifically, the single factor model was a worse fit than the proposed model with the differentiated measure- ment items ( 2 2 = 3005.697, df = 135, RMSEA= 0.142, CFI = 0.494, TLI = 0.427). Consistent withRichardson, Simmering, and Sturman (2009), in our study, common method bias was partially controlled by the design of the survey instrument: reverse-coded questions, spatial separation of dependent and independent variables, question order randomization, and survey respondent anonymity. Our survey instrument in- cluded varied questions, with some positively and others negatively worded, and different response options for some of the questions. Another possible limitation of this study is that the re- sponses are based on perceptions. Answers may reflect what respondents think is happening, but the reality may be very different. However, a multitude of studies suggests a strong link between perceptions of safety culture and safety outcomes (Katz-Navon, Naveh, & Stern, 2005; Mardon, Khanna, Sorra, Dyer, & Famolaro, 2010), lending support to our approach. Furthermore, research in other disciplines, such as environmental reporting, has shown a relationship between perceptions and reality (Cormier, Gordon, &Magnan, 2004). A third limitation involves the sampling method and generalizability of results. Our study was based on responses fromwhat was essentially a convenience sample of hospitals that voluntarily submitted data and not from a randomly selected sample of all U.S. hospitals. Nonetheless, our large sample size and our finding that structural characteristics of the database hospitals were similar to characteristics of the distribution of hospitals registered with the AHA give us confidence that these results may be similar across other U.S. hospitals. There are several paths for future studies. Because the adapted conceptual model was supported by findings from our study, this model may have relevance in future studies designed to examine other patient safety topics. In addition, future research can provide insights into the optimal way to improve teamwork across units in the context of patient safety. Future studies can also test the effect of technology and standardization in the context of teamwork across units and examine whether those factors modify the association of teamwork and handoffs. Furthermore, a future study should also be considered to clarify the role of organizational learning.

Acknowledgments

We would like to thank the Agency for Healthcare Re- search and Quality for access to the data used in this study and the Healthcare Research and Educational Trust for facilitating data access.

References

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